If you regularly experience pain right in the centre of your buttock, if it’s tender to touch and hurts to sit down, it’s possible you may be suffering from Piriformis Syndrome.
The Piriformis muscle is a small, stabilising muscle which originates from the sacrum (base of the spine) and inserts onto the greater trochanter of the femur (thigh bone). It’s a deep muscle, sitting under the glutes. The sciatic nerve runs very close to this muscle and in approximately 10% of the population it actually passes straight through the muscles fibres. If the piriformis muscle becomes tight it can compress the sciatic nerve and cause pain which can radiate down the leg, commonly known as sciatic pain.
What causes piriformis syndrome?
Overuse of the muscle (frequent running, over exercising) can cause the muscle to go into spasm. On the flip side, leading a sedentary lifestyle and sitting for long periods of time can also be a factor.
Treatment consists of two phases. First reducing pain by relaxing the muscle through ice or heat, massage and stretching. Then, when pain allows, strengthening the muscle to help prevent the injury recurring.
If the injury is very painful or inflamed then applying ice may help reduce muscle spasm and discomfort. More chronic or longer term conditions may respond better to heat and ice therapy (20 minutes of ice followed by 20 minutes of heat, 2-3 times per day) to relax the muscle however, heat should not be applied if the injury is acute, inflamed or if you suspect a muscle tear as it will only increase swelling, inflammation and bleeding.
In the short term and if the area is inflamed, take a break from any activities which make the symptoms worse. This is likely to include running and other weight bearing activities.
As soon as it is comfortable to do so, you can start some gentle piriformis stretches. Hold stretches for 30 seconds and repeat 3- 5 times.
- Lie on your back with your legs straight. Lift the painful leg and draw the knee close to your chest. Gently pull the knee across towards the opposite hip until a stretch occurs.
- Lie on your back with your legs straight. Bend the knee on the painful side and put the foot flat on the floor on the outside of the opposite knee. Pull the leg across the body with the assistance of a hand, exercise band, or towel.
Strengthening exercises should be done in addition to stretches once the pain has reduced. Ideally you will do the strength work first followed by the stretches as the muscle will be more likely to relax into a stretch if it has been worked and warmed up.
- Clam exercise – Lay on your side, bend the knees and bring them forwards so that your heels are in line with your spine. Make sure your hips are stacked one on top of the other and your back is straight. Keeping the ankles together, raise the top knee away from the bottom one making sure your hips remain stacked. Work until you feel the muscle starting to fatigue but don’t over-do it.
- Hip extension – Position yourself on all fours, hands under shoulders and knees under hips . Shift your weight slightly off the leg to be worked. Keeping the knee bent, raise the knee off the floor and slowly push the sole of the foot up towards the ceiling. Slowly lower the leg, almost back to the starting position and repeat. Repeat 15 times initially and gradually build this up to 2 sets of 20.
Deep sports massage techniques can be used to release the tension not only in the Piriformis muscle but also in the surrounding hip muscles, thighs and lower back.
If you suspect you may have piriformis syndrome and would like to discuss massage treatment or a stretching and strengthening programme, please do not hesitate to contact me: firstname.lastname@example.org.